Mental health: “Care is everybody’s right, but a privilege for only a few”
Marilen is a psychologist working in Liberia as part of a team improving care for people with serious mental health conditions such as schizophrenia and bipolar disorder.
At a Médecins Sans Frontières / Doctors Without Borders (MSF) healthcare centre in Monrovia, a 17-year-old arrives in chains. He is accompanied by his family, but he does not talk and his relatives seem to be ashamed of him.
In the waiting room, many people are looking at them, but no one is surprised by the scene. Like many others before, this teenager has been confined and shackled with the family really struggling to respond to his needs without proper support.
After an initial assessment, it’s clear that the young man needs mental healthcare. His family have brought him to our clinic because they have heard that the team here might be able to help.
“Globally, only two percent of government health budgets are designated for psychiatric care. Nowhere in the world does mental health enjoy parity with physical health.”
MSF is one of the few NGOs currently supporting mental health in Liberia. There are just a few clinics with the capacity and resources to treat mental illness in the whole country.
Many people travel long distances to seek help in the facilities we support. The needs are extremely high, but as in many countries, they are still underestimated and under-prioritised.
A worldwide problem
Liberia – one of the ten poorest countries in the world – is an example of what happens with mental health services worldwide.
Globally, only two percent of government health budgets are designated for psychiatric care. Nowhere in the world does mental health enjoy parity with physical health in terms of budget allocation.
As a consequence, in many places, there are few specialist mental health professionals and no medications to treat people who need psychiatric care.
For example, according to the World Health Organization, worldwide, 71 percent of people with psychosis do not receive appropriate treatment. The needs are overlooked, and services are sadly inadequate.
However, this problem is not restricted to very low-income countries: more than two-thirds of countries do not cover mental health services in national health insurance schemes. This means that even in places where there are available resources, frequently they are only available to the privileged and are perceived as an unnecessary luxury. An expression of class.
Mental health care is complex and can require multiple and simultaneous interventions in order to be effective.
A person might need talking therapy and psychiatric medication, for example. Sometimes the treatment needed is long-term. It is an investment. When this care isn’t available, it sends a false message: a person with a psychiatric condition is seen as beyond help, unproductive and not a worthy investment.
Stigma about mental health conditions is a virus: powerful, invisible, and contagious. It can cause serious harm for people who live with these conditions, including loneliness and low self-worth.
As a psychologist, I’ve come across people who are homeless or unemployed not because their condition means they would never be able to work, but because of the stigma which drowns them in social exclusion.
In so many places, people with psychiatric conditions are treated as the waste of society, the same feeling that pushes people into mental ill-health.
“Treatment for mental health conditions cannot be done without touching the deepest suffering of the person, a person with real flesh and blood”
Without the right treatment and support, people living with these disorders can be more vulnerable to serious human rights violations. Sexual violence and social exclusion are just some examples. Often, they draw limited attention: thinking about adequate and accessible care for them seems a utopia.
MSF’s work in Liberia provides a crucial lesson: a major barrier to mental health care is the lack of understanding and awareness. If stigma is a virus, then like other diseases, this virus must be eradicated.
One effective cure for stigma is raising awareness of mental health at all levels: among communities, healthcare service providers and governments.
After witnessing how neglected mental health care is in this country, I came to realise that Liberia is an example of the urgent global need to transform mental health services. However, I also saw how hard my MSF colleagues are working to improve things.
Back in the clinic, a mental health worker meets with the family who has brought their son in chains. As they realise that professionals are trying to help, they remove the chains from the young man’s foot and leave them on the floor.
The first thing the family receive is simply the time of the healthcare worker. In a mental health consultation, this represents interest, respect and dignity.
Treatment for mental health conditions cannot be done without touching the deepest suffering of the person, a person with real flesh and blood.
In the MSF team in Monrovia, we are constantly looking to provide holistic care that respects the integrity of the individual.
Help us prepare for the next emergency
We have a strong and highly committed team who dedicate their lives to providing effective care and who recognise the dignity of the most vulnerable.
Working with them has shown me that despite the challenges here and worldwide, Liberia is also an example of the hope needed to improve things for people who need psychiatric care.
MSF and mental health
The psychological impact of a humanitarian emergency can be severe. Our teams provide emergency medical aid in catastrophes all over the world — armed conflicts, natural disasters, famines and epidemics.
However, for people who have lived through these traumatic events, survival goes beyond ensuring physical wellbeing. Worldwide, around one in four people will suffer from a mental health problem during their lifetime, yet roughly 60 percent will not seek help.